Start: October 2008

End: December 2011

Funder: Robert Wood Johnson Foundation


Small provider practices play a critical role in caring for Medicaid beneficiaries, particularly those who are racially and ethnically diverse. The Reducing Disparities at the Practice Site initiative was developed by CHCS to support quality improvement in small practices serving this population. The three-year project helped Medicaid agencies and health plans partner with small practices to reduce racial and ethnic disparities and improve overall outcomes.

Reducing Disparities at the Practice Site sought to test the leverage that Medicaid agencies, health plans, primary care case management programs and other community-based organizations have for improving chronic care at small practices serving racially and ethnically diverse beneficiaries. These stakeholders can play a critical role in facilitating and sustaining improvements in care by providing practice sites with:

  • Data;
  • Technology;
  • Care management resources;
  • Quality improvement training; and
  • Capital.

State-led teams in Michigan, North Carolina, Oklahoma and Pennsylvania helped to build the quality infrastructure and care management capacity of “high-opportunity” primary care practices. With technical support from CHCS and experts in the field, teams helped practice sites implement interventions focused on:

  • Tracking patients and outcomes using an electronic data management tool;
  • Adopting evidence-based guidelines for targeted chronic conditions; and
  • Incorporating team-based care into ongoing practice operations.